Forms for AHCIP and Blue Cross

Forms to apply, change or update account information for AHCIP and Alberta Blue Cross, or request a Statement of Benefits Paid.

Apply for AHCIP

Update information

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Submit form

Download, complete and print the appropriate form. Do not send any information or forms by email.

Submit your application. You can:

Group forms

Blue Cross benefit forms

Alberta Blue Cross administers supplementary benefit plans on behalf of the Government of Alberta.

If you have questions about benefit forms, contact Alberta Blue Cross.

Find out how to claim for benefits through Alberta Blue Cross.

Statement of Benefits Paid

A Statement of Benefits Paid (SOBP) is a list of physician services paid for by the AHCIP on your behalf during a specific period. It includes the date and general type of service, physician name and the amount that was paid to the physician.

The requested SOBP is sent directly to the individual or their authorized representative.

Hospital services do not appear on the SOBP. These may be requested directly from the hospital.

How to order an SOBP

Current year

There is no cost for an SOBP for the most recent benefit year (July 1 to June 30) to the current year to date.

To request a current SOBP, download and complete the Request for Statement of Benefits Paid form and mail the completed form to the AHCIP office.

Or, place an order using the automated phone system:

Previous years

An SOBP can be requested back to October 1, 1993. There is a fee of $25 plus GST ($26.25) per request for individuals ordering a personal SOBP directly.

Families ordering for more than one person on the same AHCIP account pay only $26.25 for everyone.

To request an SOBP from previous years:

  1. Download and compete the Request for Statement of Benefits Paid form.
  2. Mail the completed form with your payment. Only cheques or money orders are accepted, payable to 'Government of Alberta.'

Third-party requests

If a third-party such as a law firm or insurance company wishes to request an SOBP on behalf of an Albertan, contact Alberta Health by emailing [email protected] as you will need a specific consent form not available on this web page (AHC2099).

The fee for third-party SOBP requests is $75 ($78.75 with GST).

SOBP help

Contact us if you need help, or are from a law firm or insurance company requiring this statement.

Office hours: 8:15 am to 4:30 pm, Monday to Friday, excluding holidays
Email: [email protected]